Provider Demographics
NPI:1326573320
Name:GELHAUS DENTAL CLINIC S.C.
Entity Type:Organization
Organization Name:GELHAUS DENTAL CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GELHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-748-4020
Mailing Address - Street 1:1155 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1372
Mailing Address - Country:US
Mailing Address - Phone:715-748-4020
Mailing Address - Fax:715-748-4020
Practice Address - Street 1:1155 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1372
Practice Address - Country:US
Practice Address - Phone:715-748-4020
Practice Address - Fax:715-748-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6784122300000X
WI3192122300000X
WI7139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty